It Takes a Village

Children recover from trauma through a systems approach

(RxWiki News) Children who have experienced multiple traumas face many challenges including possible PTSD, depression and anxiety. A combination of therapy and social services could provide the necessary support for a child to overcome these problems.

The results from a recent research study showed that increased stability in the child’s environment predicted improvement in the child’s ability to regulate their emotions.

These researchers found that 36 percent fewer hospitalizations were needed for children receiving therapy, and the overall lengths of stay decreased by 23 percent. 

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B. H. Ellis, PhD in the department of psychiatry in the Children’s Hospital in Boston, led a study of a program called Trauma Systems Therapy (TST), which works to help children overcome traumatic experiences and improve overall functioning.

This study tracked the course of 124 children between the ages of 3 and 20 who were enrolled in either mental health services or social services in New York between 2004 and 2006 and who participated in the Trauma Systems Therapy program.

Trauma Systems Therapy is a program for treating trauma in children and adolescents. Unlike many therapeutic approaches, the TST program provides social and environmental support to the child and their families as well as the traditional therapeutic approach of addressing the trauma individually with each child.

The program focuses on a child’s ability to regulate their emotions while also creating stability in the child’s environment. At times, this treatment includes working with a child’s school or home environment, often involving caregivers in the process.

The program first assesses each child for psychological diagnoses as well as for environmental concerns. The first step of the program after assessment is to provide social services for the child and family until the child is deemed stable enough for therapy services.

Once the child enters therapy services, he/she receives mindfulness training, emotion regulation skills training, trauma-focused exposure and cognitive therapy.

At the initial assessment for the study, all of the children were said to have experienced between three and nine potentially traumatic events, like abuse, neglect, or natural disasters; and the children were diagnosed with a variety of issues, like PTSD, depression and anxiety.

The clinical treatment, the children’s psychiatric and psychosocial functioning and social-environmental stability were measured at intake, at 4-6 months and 12-15 months. These periods were labeled “Time 1”, “Time 2” and “Time 3”, respectively.

The researchers also monitored each child’s need for crisis interventions throughout the 15-month period.

After the treatment period, the researchers looked at the cost effectiveness of the TST program by analyzing hospitalization rates and length of stay for children in the study.

The researchers found that the children’s emotion regulation, environmental stability and the children’s overall strengths and functioning improved during the 15-month treatment period.

At intake, over half of the children were in need of crisis services, by Time 2 only 37 percent needed those services, and at Time 3, only 25 percent did. Based on these findings, Medicaid expense for hospitalizations was reduced by over half, or $299,000 by the Trauma Systems Therapy model.

The research suggests that programs like Trauma Systems Therapy that work to stabilize a child’s environment while also providing therapy services can lead to better overall functioning and less frequent and shorter hospital stays for children who have experienced multiple traumas.

This study was published this year in the journal of Psychological Trauma: Theory, Research, Practice, and Policy. The author B.H. Ellis receives royalties from the book Trauma Systems Therapy, as does the author Glenn Saxe, who also receives compensation for consulting services from Child Service Solutions, LLC.

Review Date: 
November 19, 2012